Report shows oral health inequalities persist – but fewer children experience tooth decay

24 October, 2023 / infocus
 Will Peakin  

Decades of progress on children’s dental health risk going into reverse, according to the British Dental Association.

The latest report of the National Dental Inspection Programme shows that inequalities between Scotland’s most deprived and most affluent communities are widening.

Just 68.1% of P7 children in the tenth most deprived areas were found to be decay free compared with 89.7% in the tenth least deprived – a gap of 21.6%, up from 20.1% in 2019.

We have seen a narrowing in child oral health inequality

However, four out of five Primary 7 children (81.9%) in 2023 had no obvious decay experience in their permanent teeth – up from half (52.9%) in 2005.

This improvement was highlighted by Jenni Minto, the Public Health Minister, who said: “[It] is hugely welcoming, especially given the disruption to dental care due to infection prevention and control guidance that was needed to protect staff and patients at the height of the pandemic.

“While we recognise oral health inequalities in children continue to present a challenge, we have seen a narrowing in child oral health inequality, with the difference in the percentage of children with no obvious decay in the most and least deprived areas decreasing from 26.3 percentage points in 2009 to 16.1 percentage points in 2023.

“This shows the success of our flagship Childsmile Programme, where nursery and schoolchildren receive regular tooth brushing instruction and fluoride varnish application.  Given the unprecedented challenges of the pandemic, these statistics are a significant achievement.”

The BDA said it celebrated the huge progress made in recent decades, but warned that gains may not be sustainable given ongoing access problems and disruption to preventive programmes.

Earlier this year, the BDA warned the Scottish Parliament’s COVID Recovery Committee, that Scotland has lost more than a year’s worth of NHS dentistry since lockdown, and levels of activity remain “lightyears” from pre-pandemic norms.

Reform of the system of payment for NHS dentistry is being rolled out from 1 November.

While the BDA has secured some improvements, it said the Scottish Government was unwilling to make a decisive break from the “discredited low margin/high volume model that has proved incompatible with work post-pandemic”.

Question mark over sustainability

It added that there remain question marks over whether the level of change will be sufficient to keep practices sustainable and narrow inequalities of both access and outcomes.

The COVID Recovery Committee was told that the pioneering Childsmile Programme is not universally accessible across all nurseries in Scotland and that some nurseries are expressing “hesitancy” to implement it in the recovery period.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, said: “Our children are paying the price for the crisis in NHS dentistry and hard won gains are going into reverse.

 “Certainly, there is no room complacency at Holyrood, as the oral health gap between rich and poor shows little sign of closing.

“It remains to be seen if coming reforms will be enough to bring this service back from the brink. The Scottish Government cannot pretend it is ‘mission accomplished’ for NHS dentistry.”

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